Short and medium-run effects of the Indian Ocean tsunami on health costs in Indonesia.

• The tsunami increased household out-of-pocket health expenses by 35% in heavy damage areas in the short run. • Worsened mental wellbeing was associated with a 4% fall in wage earnings among men two years after the tsunami struck. • Worsened physical wellbeing was associated with a 34% fall in wage earnings among men three years after the tsunami struck. • Although the direct health costs of the tsunami were seen only in the short term, indirect costs were apparent in the medium term. This paper looks at the direct and indirect health-related monetary costs that households incurred in the short and medium terms because of the 2004 Indian Ocean Tsunami. The paper uses three rounds of a longitudinal household survey of Aceh and North Sumatra where data were collected 5–17, 18–30, and 31–40 months after the event. The results show that direct costs, measured by out-of-pocket health expenses, increased significantly by a third (35%) compared to pre-tsunami spending, for households living in heavily damaged areas. This effect, however, was seen only in the short-term, 5–17 months after the tsunami struck, and did not persist to the later years. The tsunami had significant effects on mental wellbeing as measured using the post-traumatic stress reaction score (PTSR). Among men, these changes to mental wellbeing were associated with a 4% fall in wage earnings two years after the tsunami. Physical health also worsened according to self-reported measures, and this was associated with a 34% fall in men's earnings three years after the tsunami. Thus, although the direct costs of the tsunami in terms of increasing household out-of-pocket health spending were seen only in the short term, the indirect costs via effects on mental and physical health were apparent two to three years after the event. [ABSTRACT FROM AUTHOR]